title: A multi-site feasibility study for personalized medicine in canines with osteosarcoma.
abstract: BACKGROUND
  A successful therapeutic strategy, specifically tailored to the molecular constitution of an individual and their disease, is an ambitious objective of modern medicine. In this report, we highlight a feasibility study in canine osteosarcoma focused on refining the infrastructure and processes required for prospective clinical trials using a series of gene expression-based Personalized Medicine (PMed) algorithms to predict suitable therapies within 5 days of sample receipt.
  
  
  METHODS
  Tumor tissue samples were collected immediately following limb amputation and shipped overnight from veterinary practices. Upon receipt (day 1), RNA was extracted from snap-frozen tissue, with an adjacent H&E section for pathological diagnosis. Samples passing RNA and pathology QC were shipped to a CLIA-certified laboratory for genomic profiling. After mapping of canine probe sets to human genes and normalization against a (normal) reference set, gene level Z-scores were submitted to the PMed algorithms. The resulting PMed report was immediately forwarded to the veterinarians. Upon receipt and review of the PMed report, feedback from the practicing veterinarians was captured.
  
  
  RESULTS
  20 subjects were enrolled over a 5 month period. Tissue from 13 subjects passed both histological and RNA QC and were submitted for genomic analysis and subsequent PMed analysis and report generation. 11 of the 13 samples for which PMed reports were produced were communicated to the veterinarian within the target 5 business days. Of the 7 samples that failed QC, 4 were due to poor RNA quality, whereas 2 were failed following pathological review. Comments from the practicing veterinarians were generally positive and constructive, highlighting a number of areas for improvement, including enhanced education regarding PMed report interpretation, drug availability, affordable pricing and suitable canine dosing.
  
  
  CONCLUSIONS
  This feasibility trial demonstrated that with the appropriate infrastructure and processes it is possible to perform an in-depth molecular analysis of a patient's tumor in support of real time therapeutic decision making within 5 days of sample receipt. A number of areas for improvement have been identified that should reduce the level of sample attrition and support clinical decision making.
authors.forename: Noel R
authors.initials: NR
authors.lastname: Monks
authors.forename: David M
authors.initials: DM
authors.lastname: Cherba
authors.forename: Steven G
authors.initials: SG
authors.lastname: Kamerling
authors.forename: Heather
authors.initials: H
authors.lastname: Simpson
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Rusk
authors.forename: Derrick
authors.initials: D
authors.lastname: Carter
authors.forename: Emily
authors.initials: E
authors.lastname: Eugster
authors.forename: Marie
authors.initials: M
authors.lastname: Mooney
authors.forename: Robert
authors.initials: R
authors.lastname: Sigler
authors.forename: Matthew
authors.initials: M
authors.lastname: Steensma
authors.forename: Tessa
authors.initials: T
authors.lastname: Grabinski
authors.forename: Keith R
authors.initials: KR
authors.lastname: Marotti
authors.forename: Craig P
authors.initials: CP
authors.lastname: Webb
mesh_terms: D000818:Animals; D004283:Dog Diseases / Q000628:therapy*; D004285:Dogs; D005240:Feasibility Studies; D005260:Female; D008297:Male; D012516:Osteosarcoma / Q000628:therapy / Q000662:veterinary*; D016612:Paraffin Embedding; D057285:Precision Medicine; D025341:Principal Component Analysis; D011786:Quality Control; D013997:Time Factors; D016707:Tissue Fixation